Clinical Microbiology Newsletter 29:22,2007©2007 Elsevier0196-4399/00 (see frontmatter)
173
Introduction
Micrococcus species are gram-
positive cocci (GPC) that are most fre-
quently recovered in blood cultures as
phlebotomy-associated contaminants.
However, they can be opportunistic
pathogens on rare occasions. Our case
highlights a previously reported asso-
ciation between Micrococcus spp. and
catheter infections in patients with pul-
monary arterial hypertension (PAH)
who are being treated with epoprostenol
(EPO) via central venous catheter
(CVC). To enhance prompt recognition
of clinically significant culture results,
such cases benefit from good communi-
cation between the microbiology labo-
ratory and the clinical team.
Case Report
A45-year-old man was admitted to
our hospital for evaluation of fever and
follow-up of a positive blood culture
(GPC in clusters) that was obtained by
his primary care provider (PCP) 2 days
prior to admission. He had presented to
his PCPwith a 1-week history of fever
(101.1 to 103°F), chills, nonproductive
cough, fatigue, and myalgias, for which
he was empirically started on azithromy-
cin. The patient’s medical history was
notable for Klippel-Trenaunay-Weber
syndrome, a rare congenital condition
that may include port-wine hemangi-
omas, bony and soft tissue hypertrophy,
venous malformations, and lymphatic
abnormalities of the extremities. Clin-
ical status can be complicated by
pulmonary embolism (PE), venous
thrombosis, and cellulitis. Our patient
had PE-associated pulmonary hyper-
tension, treated long-term with EPO;
(Flolan, GlaxoSmithKline), a prostacy-
clin vasodilator and platelet aggregation
inhibitor administered by indwelling
CVC.
The patient’s CVC had been in
place for 2 years and 9 months. Prior
to the current admission, he had two
remote episodes of catheter entry site
cellulitis treated successfully with
antimicrobial therapy, as well as an
uncomplicated catheter repair that was
performed 2 months prior to admission.
Upon hospital admission, the patient
was afebrile (98.3°F), with stable vital
signs and a negative review of systems.
Physical examination was notable for
bilateral lower extremity edema without
warmth or tenderness. The chest wall
catheter site was non-erythematous and
Case Report
MicrococcusBacteremia in a Patient with Pulmonary Hypertension
and a Long-term Central Venous Catheter: Opportunity Knocks,
and an Unexpected Pathogen Enters
Nancy S. Miller, M.D.,
1
Mircea C. Dobre, M.D.,
2
Jane M. Liebschutz, M.D., M.P.H.,
2,3
Tara C. Williams, M.D.,
1
Beverley L. Orr,
MT(ASCP),
1
and Harrison W. Farber, M.D.
21
Department of Laboratory Medicine and
2
Department of Medicine, Boston Medical
Center, Boston University School of Medicine,
3
Department of Social and Behavioral Medicine, Boston University School of
Public Health, Boston, Massachusetts
Mailing Address: Nancy S. Miller, M.D.,
Medical Director, Clinical Microbiology
and Molecular Diagnostics, Department
of Laboratory Medicine, Boston Medical
Center, 88 East Newton St. H3600, Boston,
MA 02118. Tel.: 617-638-8705. Fax: 617-
638-4556. E-mail: nancy.miller@ bmc.org